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Can Eliminating Risk Stratification Improve Medical Residents' Adherence to Venous Thromboembolism Prophylaxis?

Polich, Ann L. MD, MPH; Etherton, Gale M. MD; Knezevich, Jon T. PharmD, BCPS; Rousek, Justin B.; Masek, Chris M.; Hallbeck, M. Susan PhD

doi: 10.1097/ACM.0b013e318235c3f6
Graduate Medical Education

Purpose: Hospital-acquired venous thromboembolism (VTE) is a common and preventable adverse event that most patients are at risk of developing during their hospital stay. VTE prophylactic anticoagulation (chemoprophylaxis) is the preferred pharmacological assignment for reducing risk of VTE, but it is underused in current practices involving risk stratification (RS) for VTE prevention. The purpose of this study was to determine whether a protocol that eliminates the RS step (non-RS protocol) is more likely to lead residents to evidence-based VTE assignment than the currently used RS protocol. The non-RS protocol follows a methodology that reduces complexity by assuming that the risk of VTE is present and uses contraindications to determine appropriate VTE assignment.

Method: In 2009, 41 medicine residents at the Nebraska Western Iowa Veterans Affairs clinic participated in an online comparison of two different protocols (RS and non-RS) for assigning chemoprophylaxis for VTE. Six validated, hypothetical patient scenarios were used to compare appropriate (evidence-based) VTE assignments for VTE and completion times for each protocol.

Results: Statistical analyses found that the non-RS protocol produced significantly faster (P < .001) scenario completion times and significantly more (P < .001) appropriate VTE assignments than the RS protocol for four of the six patient scenarios.

Conclusions: This study used a new, streamlined protocol (non-RS), which improved VTE assignment and the use of chemoprophylaxis and simplified the process when compared with the use of a traditional RS protocol.

Dr. Polich is associate professor, Nebraska Western Iowa Veterans Affairs Health Care System and Division of General Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska.

Dr. Etherton is assistant professor, Nebraska Western Iowa Veterans Affairs Health Care System and Department of Internal Medicine, University of Nebraska Medical Center Division of General Internal Medicine, Omaha, Nebraska.

Dr. Knezevich is assistant professor, Nebraska Western Iowa Veterans Affairs Health Care System and Department of Pharmacy Practice, Creighton University School of Pharmacy and Health Professions, Omaha, Nebraska.

Mr. Rousek is a doctoral candidate, Department of Industrial and Management Systems Engineering, University of Nebraska–Lincoln, Lincoln, Nebraska.

Mr. Masek is industrial engineer, Department of Quality, Informatics and Systems Engineering, Nebraska Western Iowa Veterans Affairs Health Care System, and deputy director for applied engineering, Midwest Mountain Veterans Engineering Resource Center, Omaha, Nebraska.

Dr. Hallbeck is professor, Departments of Industrial and Management Systems Engineering, Mechanical and Materials Engineering, University of Nebraska–Lincoln, Lincoln, Nebraska.

Please see the end of this article for information about the authors.

Correspondence should be addressed to Dr. Hallbeck, W342 Nebraska Hall, Lincoln, NE 68588-0526; telephone: (402) 472-2394; e-mail: Hallbeck@unl.edu.

First published online October 25, 2011

Supplemental digital content for this article is available at http://links.lww.com/ACADMED/A63.

© 2011 Association of American Medical Colleges